Citation Nr: 9933818
Decision Date: 12/03/99 Archive Date: 12/10/99
DOCKET NO. 94-42 942 ) DATE
)
)
On appeal from the
Department of Veterans Affairs (VA) Regional Office (RO)
in Philadelphia, Pennsylvania
THE ISSUE
Entitlement to an increased rating for anxiety neurosis,
currently evaluated as 70 percent disabling.
REPRESENTATION
Appellant represented by: Disabled American Veterans
WITNESS AT HEARING ON APPEAL
Appellant
ATTORNEY FOR THE BOARD
Debbie A. Riffe, Associate Counsel
INTRODUCTION
The veteran had active service from March 1971 to January
1974. This case comes to the Board of Veterans' Appeals
(Board) on appeal from a June 1994 rating decision of the RO
which denied the veteran's claim for an increase in a 50
percent rating for anxiety neurosis. In September 1997, the
Board remanded the case to the RO for additional development.
In a September 1998 rating decision, the RO assigned a 70
percent rating for the anxiety neurosis. The appeal for an
increased rating continues.
FINDINGS OF FACT
The veteran's service connected anxiety neurosis, with
depressive features, produces no more than severe social and
industrial impairment; and the condition produces no more
than occupational and social impairment with deficiencies in
most areas (such as work, family relations, judgment, and
thinking) due to various symptoms.
CONCLUSION OF LAW
The veteran's anxiety neurosis is not more than 70 percent
disabling. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R.
§ 4.132, Diagnostic Code 9400 (1996), § 4.130, Diagnostic
Code 9400 (1999).
REASONS AND BASES FOR FINDINGS AND CONCLUSION
I. Factual Background
The veteran served on active duty from March 1971 to January
1974. Service and post-service medical records show
treatment for psychiatric symptoms including anxiety. In a
May 1981 decision, the RO granted service connection and a 30
percent rating for an anxiety neurosis with depressive
features. A January 1992 RO decision increased the rating
for this disability to 50 percent.
A number of medical records from 1993 note a history of
anxiety and depression, but these records primarily show
treatment for physical ailments such as heart disease.
VA outpatient records from March 1994 note the veteran was
seen for his physical ailments, also complained of anxiety
and depression, and reported he had not worked since June
1993. Medication was prescribed for psychiatric symptoms and
further treatment was planned for the nervous disorder.
In March 1994, the veteran through his representative
submitted a claim for an increased rating for anxiety
neurosis.
A VA mental hygiene clinic intake evaluation record dated in
April 1994 indicates a complaint of severe depression. It
was noted that the veteran had two myocardial infarctions in
June 1993 and took sick leave from work. He said he then
became depressed and stayed in his bedroom alone from
November 1993 to March 1994. He related that he had eating
problems and did not bathe during this period, and eventually
his wife brought him to the VA medical center for treatment.
He said he began seeing a psychiatrist and was now going out
of his house daily. He expressed an interest in returning to
work. As for recreational activities, the veteran indicated
he no longer golfed, due to his heart disorder, but he
continued to fish and enjoyed such. It was noted that the
veteran had depressive mood symptoms and he reported he
experienced daily panic attacks. On mental status
examination, the veteran was neatly dressed and groomed. He
sat fairly still but became somewhat more animated as the
interview progressed. His mood was slightly depressed, and
his affect was mildly constricted. His speech was at a
normal rate and tone. There were no hallucinations. His
thought processes were goal-directed. Regarding thought
content, the veteran was concerned about his depression and
panic attacks. His short and long term memory appeared to be
intact. He was oriented to time, place, and person. His
judgment was fair and his insight was good. The diagnoses
included major depression in partial remission, panic
disorder with agoraphobia, history of alcohol dependence, and
rule out personality disorder. Medication was prescribed and
future treatment was planned.
On an April 1994 VA examination, the veteran complained that
he had severe depression, panic attacks, crying spells, and
insomnia. He indicated that he could not function in
"regular" life and support his family. He indicated that
he had suicidal thoughts and was locked up in his room for
four months. It was noted that the veteran last worked in
January 1993 for the post office where he had been for 12
years. He said he went for treatment every two weeks and
took medication for his psychiatric problems. He also
reported recent treatment for physical ailments such as heart
disease. The veteran related he had panic attacks on an
irregular basis and more often when he went out of the house.
During a panic attack, he said, he had chest pain, difficulty
breathing, sweating, and feelings of dizziness. He said he
had bouts of severe depression with suicidal thoughts, and
stayed in his room for weeks at a time. On examination, the
veteran looked his age and was casually dressed. He was
tense and anxious. He gave relevant answers and was
coherent. He denied any hallucinations and persecutions. He
was worried, and his emotional reaction was markedly
depressed. He was oriented but showed some memory lapses.
His insight and judgment were fair. The diagnosis was
anxiety disorder with depressive features, aggravated by
physical illnesses. The Global Assessment of Functioning
(GAF) scale score was 50.
Records dated in May 1994 from Taylor Hospital show an
admission for unstable angina. It was noted that prior to
being seen in the emergency room the veteran had planned on
returning to work. On examination, the veteran was
depressed. The hospital records show he was primarily
treated for heart disease, although depression was also
noted.
A May 1994 VA outpatient record indicates that the veteran
had severe anxiety and depression complicated by the stress
of life-threatening cardiovascular disease. He had recently
begun a medication regimen prescribed by a psychiatrist
contracted with the post office. A June 1994 record notes
his diagnoses included coronary artery disease, hypertension,
and depression.
In a June 1994 letter, Philip Bhark, M.D., noted the
veteran's diagnosis of unstable angina and excused him from
work until June 1994. In a June 1994 statement, Elmer
Thompson, M.D., indicated that the veteran was under his care
for severe gastritis and depression and that he would be able
to return to work the next day.
An RO rating decision in June 1994 denied the veteran's claim
for an increase in a 50 percent rating for anxiety neurosis.
At a November 1994 hearing at the RO before a hearing
officer, the veteran's representative indicated that despite
the veteran's extreme difficulties with his service connected
disabilities he continued to maintain gainful employment.
The veteran testified that he has had considerable difficulty
with his nerves and depression; that as recent as August 1994
he cut his left arm on account of his nerves; that he
constantly contemplated suicide; that he had no friends and
did not associate with anyone; that his relationship with his
wife was "very bad;" that he only left his house to go to
work at the post office and to get gas in his car; that he
had been at the post office since 1983 but had difficulties
with supervisors due to absenteeism on account of his nerves;
that he worked alone and was unsupervised for much of the
time; that he believed others at work were afraid of him;
that he had been receiving treatment from Dr. Silverman, who
was on consultation with the post office, every two weeks to
once a month since April 1994; that he was locked up in his
room for six months up until April 1994 and eventually went
back to work in September 1994; that he had a quick temper,
suffered panic attacks and crying spells, and had a great
deal of depression; that if he lost his job at the post
office no one would hire him; that he went on medical leave
from his post office job from 1992 to 1994; and that he has
physically harmed himself because he felt angry.
In a November 1994 statement, Lee Silverman, M.D., of Mercy
Catholic Medical Center, indicated that the veteran had been
his patient since April 1994 and that the veteran's
psychiatric diagnoses included major depression and anxiety
disorder. He stated that when he first met the veteran he
was nonfunctional, very withdrawn, and at times very
irritable and violent, possibly paranoid with very poor sleep
and appetite. After aggressive treatment measures, the
veteran had a significant improvement in his level of
function and recently returned to work at the post office.
Dr. Silverman noted that the veteran had severe coronary
artery disease and that at times it was difficult to
differentiate between chest pain and symptoms of cardiac
origin and those of primary anxiety origin.
On a December 1994 VA examination, the veteran complained of
an inability to sleep without medication. He said he was
tense and anxious for much of the time. He reported
recurrent panic attacks with difficulty breathing, rapid
heart beat, and dizzy spells. He had bouts of severe
depression with suicidal thoughts and guilt feelings. The
veteran reported he was out of work at the post office
between January 1993 and September 1994 due to his illness.
On examination, the veteran looked his age and was suitably
dressed. He was tense and anxious. He gave relevant answers
and was coherent. He denied any hallucinations, and he did
not relate any persecutions. He was worried, and his
emotional reaction was depressed. He was oriented but showed
some memory lapses. His insight and judgment were fair. He
was deemed competent for VA purposes. The diagnosis was
anxiety disorder with depressive features, aggravated by
physical illnesses. The GAF scale score was 50.
In an August 1995 statement, Dr. Silverman stated that the
veteran suffered from a relatively severe recurrent
depressive illness with relatively severe anxiety symptoms.
He also suffered from chronic insomnia, irritability, and an
explosive temper that at times caused him to become
destructive to property and self-injurious. The veteran had
significant difficulties in interpersonal relationships. It
was noted that his mental illness was significantly affected
by his medical problems that included coronary artery disease
with anginal chest pain and migraine headaches. The
veteran's illness impaired his ability to tolerate many
social situations. He was presently quite isolated in his
social contacts and had significant difficulty with the
stress of his own marriage and childrearing of a teenager.
If the veteran had been in a situation of applying for and
adapting to a new work situation or job, his mental illness
would severely impair his ability to do this. However, the
veteran had been working for a long time at his present post
office job on the evening or night shift where he had little
contact with other employees. Dr. Silverman believed that
the veteran was best served by being able to maintain his
current employment, in spite of the fact that intermittent
absences from work due to exacerbation of his illness had to
be expected. It was in the veteran's best interest to
continue working at his job, aiding his self esteem and
keeping him in contact with the outside world. Dr. Silverman
believed that if the veteran lost his job he would very
quickly become isolated and suffer severe decompensation,
which had been proven in the times that he had missed work
for more than a week or two and had regressed considerably.
In a subsequent August 1995 statement, Dr. Silverman
indicated that on an office visit that same month the veteran
was anxious, irritable, depressed, and unable to concentrate.
The veteran almost appeared in need of hospitalization, and
Dr. Silverman advised him to take the next several days off
from work.
Medical records dated in August 1995 from Mercy Catholic
Medical Center indicate that the veteran was hospitalized for
three days. The veteran was admitted with complaints of
depression, anxiety, and somatization. It was noted that he
was unable to stay stable and/or safe outside of the hospital
for more than one to two weeks at a time. On mental status
examination, the veteran was superficially pleasant with an
undertone of rage and anger. He was hypervigilant,
irritable, and had positive suicidal ideation and violent
thoughts towards his wife. He had poor insight and impaired
judgment, and he was cognitively intact. He was discharged
with a guarded prognosis. His final diagnoses included major
depression and narcissistic personality disorder.
On a January 1996 VA examination, the veteran complained that
he was often scared and anxious and that at times he had
attacks of hyperventilation and bouts of depression lasting
for several months. He felt that his supervisors at work
picked on him, and he would get angry and yell at people. It
was noted that he was working as a clerk at the post office.
On examination, the veteran looked his age and was suitably
dressed. He showed average psychomotor activity. He gave
relevant answers and was coherent. At times he gave a brief
response and was evasive. He was suspicious, indicating that
his supervisor picked on him, but frank persecutions were not
elicited. The veteran's affect was moderately depressed. He
was oriented but frequently responded that he did not
remember. He demonstrated some memory lapses. His insight
and judgment were fair. The veteran was deemed competent for
VA purposes. The diagnosis was anxiety neurosis with
depressive features. The GAF scale score was 60.
In a February 1996 statement, Dr. Silverman indicated that
the veteran suffered from a relatively severe and treatment-
resistant psychiatric illness with symptoms of anxiety,
depression, somatization, and irritability. In spite of
aggressive treatment through medication, the veteran had been
intermittently symptomatic and at times unable to work
secondary to the degree of his impairment. The treatment and
recovery of his psychiatric illness were complicated by
multiple physical illnesses. Dr. Silverman stated that in
spite of his best efforts and treatment, he had been unable
to maintain the veteran in a condition that allowed
consistent full-time employment and that this intermittent
employment had only been possible through the ongoing use of
aggressive pharmacotherapy with multiple agents.
In a July 1997 statement, Dr. Silverman summarized the
veteran's psychiatric treatment. He stated that he had been
treating the veteran since April 1994 when he reported many
months of inability to function, inability to work with poor
appetite, poor sleep, suicidal thoughts, acts of self-
destructiveness, and isolation in his room. He had been
extremely anxious with what appeared to be panic attacks and
agoraphobia. During the intervening three year treatment
period, the veteran was noted to have very poor ability to go
to work for periods longer than several weeks. He had spent
most of that time nonfunctional at home, in spite of
relatively good compliance with medication. The early part
of the veteran's treatment was characterized by
decompensations and hospitalizations with marked affective
lability, irritability, ragefulness, and self-
destructiveness. More recently, the veteran had been seen
with a vegetative depression with severe psychomotor
retardation, thought blocking, and poor activities of daily
living. Most recently, there had been a significant change
in him, possibly due to recent additions to his medication
regimen, whereby he appeared to be in a perpetual hypomanic
state with increased energy, decreased sleep, mild euphoria,
and mild flight of ideas. Dr. Silverman noted that the
veteran had been able to maintain consistent employment over
the past six weeks, which was a dramatic change for him. The
doctor was concerned about the possible instability of the
veteran's psychiatric condition and the possible long-term
effects of his complex polypharmacologic regimen. In sum,
Dr. Silverman said that during most of the time of treatment
the veteran was severely disabled by his condition and unable
to consistently maintain employment. Very recently, there
had been a significant improvement in the veteran's level of
function due to a complex and somewhat risky
polypharmacologic regimen. It was difficult to predict
whether the current level of function would continue. The
veteran's diagnoses included severe, recurrent major
depression and panic disorder with agoraphobia (Axis I), and
mixed personality disorder with narcissistic and borderline
traits (Axis II). Psychosocial stressors were identified as
severe marital discord (Axis IV). A chronic baseline level
of functioning (GAF scale score) of approximately 40 to 50
over the past three years and of approximately 80 over the
past month was reported (Axis V).
Medical records dated from June 1995 to April 1998 from Dr.
Silverman include numerous reports from Mercy Catholic
Medical Center, reflecting hospitalizations in June 1995,
July 1995, July to August 1995, August 1995, April 1996,
September 1996, December 1996, March to April 1997, June
1997, October 1997, January 1998, and April 1998. The
reports show psychiatric treatment for and diagnoses of major
depression, mixed personality disorder with borderline
narcissistic traits, narcissistic personality disorder,
alcohol abuse, post-traumatic stress disorder, anxiety
disorder not otherwise specified, and intermittent explosive
disorder. During an April 1998 admission, the veteran
reported a recent relapse of alcohol addiction. Dr.
Silverman was the attending physician.
In a May 1998 statement, Dr. Silverman indicated that the
veteran had a severe, chronic mental illness with symptoms of
depression, anxiety, explosive rage, and at times violence
and self-mutilation. For most of the time that the veteran
had been his patient, he had been unable to maintain any type
of consistent employment. While on a very complex regimen of
medications, the veteran had been able to work consistently
at the post office for the past 8 to 12 months. It was not
known how long this would continue, and in spite of his
employment the veteran continued to have intermittent
hospitalizations for psychiatric decompensations and ongoing
psychiatric symptoms such as sleep disturbance, anxiety,
depression, and explosiveness. Dr. Silverman believed that
the veteran's mental illness was severe, chronic, and
treatment-refractory.
On a June 1998 VA examination, it was noted that the veteran
had worked for the postal service for 16 years. On
examination, he came across in the interview as very gruff
and angry. He was not particularly reliable as a historian
because he was at times tangential and seemed to want to
complain and protest how ill he was and how overwhelmed he
had been. He seemed more compelled to describe his feelings
than to easily cooperate with providing accurate information.
The veteran predicted that on his way home from the
examination he would feel anxious and have to stop along the
way to calm down. The examiner noted that the veteran had a
chronic mood disorder, not otherwise specified, with
depressive and anxious features, which had been fairly
debilitating over the years. There was not sufficient
evidence to indicate that the veteran had been completely
psychotic, although at times he had had some difficulty with
his judgment and reality testing. The GAF scale score was
45, indicating the seriousness of his emotional impairment
due to his disorder and the interference with his
occupational and social functioning.
In a September 1998 rating decision, the RO assigned a 70
percent rating for the veteran's anxiety neurosis with
depressive feature, effective from March 1994.
II. Legal Analysis
Initially, it is noted that the veteran's claim for an
increase in a 70 percent rating for an anxiety disorder is
well grounded within the meaning of 38 U.S.C.A. § 5107(a).
That is, he has presented a claim which is plausible. The
Board is satisfied that all relevant evidence has been
properly developed and that no further assistance is required
to comply with the duty to assist as mandated by 38 U.S.C.A.
§ 5107(a).
Disability evaluations are determined by the application of a
schedule of ratings which is based on average impairment of
earning capacity. Separate diagnostic codes identify the
various disabilities. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4.
When rating a disability, the entire medical history must be
considered. However, in a claim for an increased rating, the
more recent evidence is generally the most relevant, as the
present level of disability is of primary concern. Francisco
v. Brown, 7 Vet. App. 55 (1994).
The Board notes that the regulations pertaining to evaluating
mental disorders were revised effective November 7, 1996,
during the pendency of the present appeal. Under the
circumstances of this case, either the old or new rating
criteria may apply, whichever are most favorable to the
veteran. Karnas v. Derwinski, 1 Vet. App. 308, 313 (1991).
Under the old rating criteria, in effect prior to November 7,
1996, a 70 percent evaluation for anxiety neurosis requires
that the ability to establish and maintain effective or
favorable relationships with people is severely impaired and
that psychoneurotic symptoms are of such severity and
persistence that there is severe impairment in the ability to
obtain or retain employment. A 100 percent evaluation is
warranted where the attitudes of all contacts except the most
intimate are so adversely affected as to result in virtual
isolation in the community; or where there are totally
incapacitating psychoneurotic symptoms bordering on gross
repudiation of reality with disturbed thought or behavioral
processes associated with almost all daily activities such as
fantasy, confusion, panic, and explosions of aggressive
energy resulting in profound retreat from mature behavior; or
the individual is demonstrably unable to obtain or retain
employment. 38 C.F.R. § 4.132, Diagnostic Code 9400 (1996).
Under the new rating criteria, in effect since November 7,
1996, a 70 percent rating will be assigned for an anxiety
neurosis or other mental disorder when occupational and
social impairment, with deficiencies in most areas, such as
work, school, family relations, judgment, thinking, or mood,
due to such symptoms as: suicidal ideation; obsessional
rituals which interfere with routine activities; speech
intermittently illogical, obscure, or irrelevant; near-
continuous panic or depression affecting the ability to
function independently, appropriately and effectively;
impaired impulse control (such as unprovoked irritability
with periods of violence); spatial disorientation; neglect of
personal appearance and hygiene; difficulty in adapting to
stressful circumstances (including work or a worklike
setting); inability to establish and maintain effective
relationships. A 100 percent rating will be assigned when
there is total occupational and social impairment, due to
such symptoms as: gross impairment in thought processes or
communication; persistent delusions or hallucinations;
grossly inappropriate behavior; persistent danger of hurting
self or others; intermittent inability to perform activities
of daily living (including maintenance of minimal personal
hygiene); disorientation to time or place; memory loss for
names of close relatives, own occupation, or own name.
38 C.F.R. § 4.130, Diagnostic Code 9400 (1999).
In addition to his service-connected acquired psychiatric
disorder, the veteran has a non-service-connected personality
disorder and alcohol dependence. Impairment from the non-
service-connected conditions may not be considered in support
of an increased compensation rating. 38 C.F.R. § 4.14.
The veteran contends that his service-connected anxiety
neurosis is more disabling than is reflected by his 70
percent rating. He testified at an RO hearing in November
1994 that he had considerable difficulty with his nerves, did
not associate with anyone, and worked alone at his job.
However, after consideration of all evidence of record, the
Board concludes that the veteran's anxiety neurosis does not
meet the rating criteria for a 100 percent rating under
either the old or revised regulations.
A number of medical records suggest that the major reason for
the veteran temporarily stopping work at his post-office job
in 1993 was his physical ailments such as heart disease,
rather than his psychiatric disorder. In March 1994, he
sought treatment for his nervous symptoms. An April 1994 VA
mental hygiene clinic record shows that he complained that he
was depressed and had remained in his bedroom for months
until the previous month when he began to leave his house
daily. He also desired to return to work then. At the time
of his April 1994 VA examination, the veteran reported he
experienced panic attacks on an irregular basis and had bouts
of severe depression with suicidal thoughts. His GAF score
was 50, representing serious symptoms or any serious
impairment in social or occupational functioning. The veteran
continued to experience bouts of depression with suicidal
thoughts, as reported on the December 1994 VA examination,
but it was also noted that he was coherent, without
hallucinations, and oriented. His GAF score remained at 50.
His GAF score improved to 60, representing moderate symptoms
or moderate difficulty in social or occupational functioning,
on VA examination in January 1996. At that time, the veteran
was anxious, and he reported he experienced attacks of
hyperventilation and bouts of depression, and was suspicious
of his supervisors. Nevertheless, there were no
persecutions, and he was oriented and coherent. The most
recent VA examination in June 1998 indicates that the veteran
still worked for the postal service after 16 years. His GAF
score was 45, representing serious impairment in social and
occupational functioning.
The private medical records further reflect that the level of
the veteran's social and occupational impairment was serious
or severe, but not total. The medical evidence indicates
that the veteran's delay in returning to work in May 1994 was
due to his severe cardiovascular disease. Dr. Silverman
stated in November 1994 that at times it was difficult to
differentiate between the veteran's symptoms of cardiac
origin and those of anxiety origin. Dr. Silverman began
treating the veteran's psychiatric disorder in April 1994,
and he indicated that in the early years of such treatment
the veteran had poor ability to go to work longer than
several weeks and otherwise spent his time nonfunctional at
home. At that time, the veteran had marked affective
lability, irritability, rage, and self-destructiveness, and
his GAF score was 40 to 50. In July 1997, a significant
change was noted in the veteran, and he was able to maintain
consistent employment. His GAF score improved to 80,
representing slight impairment in social and occupational
functioning. Thereafter, Mercy Catholic Medical Center
records indicate that the veteran still continued to be
hospitalized on an intermittent basis for psychiatric
decompensations, in October 1997, January 1998, and April
1998. The most recent assessment from Dr. Silverman in May
1998 is that the veteran's psychiatric disorder was severe
and chronic, preventing him from maintaining any type of
consistent employment except for the previous 8 to 12 months.
His ongoing symptoms were identified as depression, anxiety,
explosive rage, violence, and self-mutilation.
Considering the old rating criteria, the veteran's overall
disability picture does not reflect that his condition is
productive of more than severe (70 percent) social and
industrial impairment. The veteran is gainfully employed and
has been working in the same job for the post office for many
years, despite intermittent interruptions due to
hospitalizations for his psychiatric disorder. While Dr.
Silverman indicates that in the early years of his treatment
the veteran was unable to maintain consistent full-time
employment due to the periodic decompensations and
hospitalizations, the record shows that the veteran
nevertheless remained employed by the postal service.
Although over a three year period the veteran was
hospitalized a number of times, most of these stays did not
exceed more than a few days. The evidence shows the
veteran's psychiatric disorder does not meet the old criteria
for a 100 percent rating. He is not demonstrably unable to
obtain or retain employment. Also, while recognizing that
the veteran's social contacts may be severely limited, he
remains employed, interacting at least with supervisors at
work. It cannot be said that he is virtually isolated in the
community. In fact, Dr. Silverman stated in August 1995 that
although the veteran was quite isolated in his social
contacts it was in his best interests to continue working at
his job, in spite of the intermittent absences from work due
to exacerbation of his mental illness, because it aided his
self esteem and kept him in contact with the outside world.
Finally, the veteran's psychoneurotic symptoms are not
totally incapacitating and bordering on gross repudiation of
reality. The medical evidence reflects panic attacks and
explosions of aggressive energy at times, but the VA
examinations indicate that the veteran generally is oriented
and coherent and does not have hallucinations or
persecutions. The veteran was hospitalized intermittently
for psychiatric decompensations, yet the overall picture does
not reflect that he has disturbed thought or behavioral
processes that result in profound retreat from mature
behavior.
The veteran's overall psychiatric disability picture also
does not meet the new rating criteria for a 100 percent
rating; nervous symptoms do not result in total occupational
and social impairment. There is no objective evidence of
gross impairment in thought processes or communication,
persistent delusions or hallucinations, disorientation to
time or place, or memory loss for names of close relative,
own occupation, or own name. He shows some memory lapses on
VA examination but is generally oriented. He remains
employed in the post office. The veteran's symptoms of
suicidal ideation, bouts of severe depression, episodes of
panic attacks, irritability, explosive rage, significant
difficulty in interpersonal relationships, and isolation in
social contacts are reflective of the criteria for a 70
percent rating. The evidence demonstrates that the veteran's
anxiety neurosis produces no more than occupational and
social impairment with deficiencies in most areas, such as
work, family relations, judgment, thinking, and mood, due to
various symptoms. No more than a 70 percent rating is
warranted under the new criteria.
In sum, the Board finds that the preponderance of the
evidence is against the veteran's claim. Thus, the benefit-
of-the-doubt doctrine is inapplicable, and an increased
rating for anxiety neurosis must be denied. 38 U.S.C.A.
§ 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990).
ORDER
An increased rating for anxiety neurosis is denied.
J. W. TOBIN
Member, Board of Veterans' Appeals